I am passing along a story to encourage other people to think about such issues. (As you may know, the reason I have my psychology and law degrees was to work on Capitol Hill on health care legislation, and actually contributed to an Omnibus Medicare-Medicaid Act. Realizing I might make a larger contribution to changing systems by working off the Hill, I did. This even reminded me again of the need for all of us to get involved.
A recent widow, who is approaching 90 years of age, recently visited a new doctor for a relatively simple checkup. Covered by her insurance company’s supplemental Medicare, all she received was a summary of charges. Looking at it she saw visits to that doctor and others for services she did not recall receiving. Being somewhat disoriented, she had a family member call the (well known) Health Insurance Company to obtain the actual bills to see if they were accurate. That began the horror story.
The summary stated the company’s customer service was available till 7PM, but it wasn’t, it closed at 5PM; so the person needed to take time off during work the next day to make the call. Despite having power of attorney for the person (hereafter called the consumer), customer service demanded speaking to the consumer, who was staying at someone else’s house. Over 2 hours later, with a total of 4 people speaking to the customer service, they agreed to send a form to the consumer giving the company permission to give her copies of her own bills!
Two weeks later, nothing arrived. A letter was written to request it and was going to be sent to customer service, but due the poor service, was sent instead to the company’s CEO, so he could address the policy behind this problem. Ten days later, not even a phone call acknowledging the letter. A second letter was sent; again no acknowledgement.
So another call was placed to customer service to request the bills. It took almost 2 hours and three customer service people, including a supervisor, to say that the company would not provide consumers with the bills sent on their behalf by doctors! Instead she should contact the doctors (who, as you remember, she believes might have committed Medicare fraud). A call was made to the one doctor she visited, and after first hanging up, the customer service person reported that they wouldn’t provide the bill to the consumer. Finally, a friend who was a doctor offered to make the call on behalf of the consumer and the bill was faxed to him. At this point, over four months had passed since the initial visit, and the consumer, being confused about it all was encouraged to drop the matter.
Obviously there are many issues here. But the one that’s most disturbing is that in a world of health care reimbursement, if a consumer takes the time to report potential fraud, the insurance company feels no obligation to help the person pursue it. Is this a future trend to watch as government-supported reimbursement systems increasingly take over payments for health care.
What do you think? Have you had any such experiences? Please share….remember our health care system that affects all of us when we pay for insurance, pay for taxes the support the public reimbursements and as consumers of the care!